[Antibiotic prophylaxis and hernia repair. Systematic quantitative review results]

The usefulness of the antibiotic prophylaxis in hernia repair is currently a controversial subject. Comparative studies have shown disparate results, and that is why it is difficult to have a clear idea of its utility. The purpose of the present study is to make a systematic quantitative review or meta-analysis of the published controlled studies on antibiotic prophylaxis in hernia repair, to give the best possible evidence as to the effectiveness of this prophylaxis.

The described steps for the realization of a systematic quantitative review, based on the practice of evidence based medicine, have been followed. The steps are these: formulation of a relevant question (is antibiotic prophylaxis useful in open inguinal hernia repair in the prevention of post-operative infection of surgical wound?), search of the best available evidence, selection criteria of those trials found, analysis of each one of them, combination of the results (Yusuf and Peto method) and conclusions.Results. Twelve studies were found, of which eight fulfilled the inclusion criteria for the meta-analysis. Our results show that antibiotic prophylaxis in hernia repair, whether prosthetic material is used or not, diminishes the rate of infection by 42%, 61% and 48% in herniorraphies, hernioplasties and the two combined, respectively. The number of patients to whom prophylaxis was administered in order to avoid a post-operative infection was 42 for herniorraphies, 37 for hernioplasties and 40 for general hernia repair.Conclusions. Antibiotic prophylaxis in hernia repair is useful in preventing wound infection. Nevertheless, this does not imply its indiscriminate administration, rather it is necessary to base it on the local rate of wound infection and on the analysis of the patients' risk factors in order to avoid its administration when the possible benefit is considered to be limited.